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Case Study: PeachTree Healthcare


Issues
1. Incompatible architecture and lack of standardization at Peachtree Healthcare
2. Patchwork infrastructure is causing frequent downtime, thereby affecting patient-care and
technical innovation
3. Disagreement over implementing standardized practices vs. providing physicians the
independence to make treatment decisions
4. Multiple risks associated with the architectures being considered for implementation:
cost, rigidity of solution, market-maturity etc.
Problem
The CEO needs to decide on a strategy for a long-term solution to fix Peachtrees patchwork-
ed IT infrastructure issues
Decision
The company needs to decide whether to go for broad standardization vs. flexibility and
independent decision-making for physicians; they also need to decide on the architecture:
monolithic, SOA etc. after weighing in the risks/cost.
Alternatives
1. Do nothing; wait until increased adoption of newer architectures, and then take a more
informed decision
2. Implement selective standardization/SOA for ALL the business processes in one shot
3. Implement SOA in a phased manner; start with the least risky tasks first
4. Implement broad standardization/monolithic-architecture for the whole federation
Criteria
1. Values Peachtrees vision-statement: Health-care Quality, Consistency and Continuity
(3)
2. Risk Downtime/Performance of existing infrastructure; cost/project-duration etc. for
new architecture (4)
3. Flexibility/Independence Quick response to change; decision-making by physicians (3)

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Evaluation
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1 3 6 5 56 Deferring implies severe risk of downtime-issues/low service-
quality
2 4 2 10 50 Very high-risk option that could affect the quality and consistency
and shut down the hospitals entirely
3 7 7 10 79 Measured risk; provides flexibility to change, supports
independent decision-making by physicians, preserves
consistency/continuity of service
4 5 9 3 60 Low risk proven architecture, however it comes at the cost of
flexibility to change
Recommendation
Alternative 3: Managed-risk-taking by starting with the least risky tasks in phase-I, and using
phase-I estimates to get more accurate data around costs and project duration for phase-II
forecasts. This alternative is also in alignment with Peachtrees overall vision.
Action Plan
1. Quickly build a consensus around selective standardization/SOA
a. Risk: Staff/Board rooting for broad standardization may not be receptive
b. Mitigation: Involve physicians in the decision-making process (understand the end-
user perspective)
c. Who/When: CEO/Immediately
2. Issue RFP and decide on the best IT company for the project
a. Risk: Lack of information about SOA may lead to wrong choice of the company
b. Mitigation: Hire independent consultants, form a committee to make the decisions,
build air-tight contracts
c. Who/When: CEO/After completion of action 1
3. Inform the patients/public about Peachtrees architecture-upgrade project
a. Risk: Patients may fear interruptions and/or quality of health-care to go down
b. Mitigation: Stress on adherence to quality and continuity during the upgrade
c. Who/When: CEO/After completion of action 2
4. Announce the team and get the project started
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a. Risk: Impact to patient health-care; timelines/costs may deviate from the contract
b. Mitigation: Start with less-risky tasks first use this phase to acquire accurate
estimates of timeline/costs for the riskier phases that impact patient healthcare
Who/When: CEO/In parallel with action 3